Background/Purpose:

To study the effect of the metabolic syndrome (MetS) on organ damage, renal function and mortality in patients with SLE.

Methods:

Consecutive patients who fulfilled ≥4 ACR criteria for SLE and were assessed for the presence of MetS between 2010 and 2011 were included. The MetS was defined by the updated joint consensus criteria, using the Asian criteria for central obesity, when >=3 of the following were present: (1) Increased waist circumference to >= 90cm in men or 80cm in women; (2) Elevated blood pressure to ≥130/85mmHg or requiring drug therapy; (3) Elevated serum triglyceride level to ≥1.7mmol/L; (4) Reduced serum HDL-cholesterol to ≤1.0mmol/L in men and ≤1.3mmol/L in women; and (5) Elevated fasting glucose level to ³5.6mmol/L. Longitudinal data regarding change in renal function (4-variable eGFR), new organ damage, vascular events and mortality were retrieved from our cohort database. The association of the MetS with new organ damage and mortality was studied by logistic regression.

Results:

577 SLE patients were studied (93% women; age 41.2±13.4 years; SLE duration 9.3±7.2 years). All were ethnic Chinese and the mean follow-up was 66.3±1.8 months. The mean body mass index of the patients was 22.3±3.9kg/m² (11% >27kg/m²). A total of 85 (14.7%) patients qualified the MetS (28% fulfilling waist; 20% fulfilling blood pressure; 25% fulfilling triglyceride; 33% fulfilling HDL and 9.2% fulfilling glucose criteria). New organ damage and vascular (coronary, cerebrovascular and peripheral vascular) events developed in 128 (22%) and 23 (4.0%) patients, respectively. The commonest new arterial events were stroke(50%), acute coronary syndrome(33%) and peripheral vascular disease(17%). Thirty-nine(6.8%) patients died (infection 36%; vascular causes 18%; cancer 15%; lung fibrosis 8%; suicide 3%). Patients with the MetS (N=85), when compared to those without (N=492), had significantly higher SDI accrual at last visits (0.70±1.0 vs 0.26±0.6; p<0.001). Regarding individual systems, the increase in SDI scores in the ocular, renal, cardiovascular, musculoskeletal and endocrine (new diabetes mellitus) systems were significantly higher in the MetS group of patients. Patients with the MetS had a significantly greater decline in eGFR over time (-18.2±27% vs -7.80±19%; p=0.002). New vascular events (11% vs 2.8%; p=0.001), all-cause mortality (14% vs 5.5%; p=0.003), vascular mortality (7.1% vs 0.2%; p<0.001) were significantly more common in patients with MetS. Logistic regression revealed that the MetS was significantly associated with new damage in the ocular (OR 2.77[1.05-7.34]; p=0.04, renal (OR 4.72[1.86-12.0]; p=0.001), cardiovascular (OR 3.66[1.03-12.9]; p=0.04] and endocrine system (OR 41.9[4.93-357]; p=0.001), adjusted for age, sex, SLE duration and the antiphospholipid antibodies. The MetS increased the risk of new vascular events (OR 2.94[1.18-7.31];p=0.02), all-cause mortality (OR 1.60[0.73-3.47];p=0.24) and vascular mortality (OR 30.3[3.42-268];p=0.002) after adjustment for the same covariates.

Conclusion:

In this 5-year longitudinal study, the MetS is significantly associated with new organ damage, more renal function decline, vascular events and mortality in patients with SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-the-metabolic-syndrome-on-organ-damage-renal-function-and-mortality-in-patients-with-systemic-lupus-erythematosus-a-longitudinal-analysis/